Prostate Flashcards
?
Glandular units in the prostate that undergo an incr in the # of cells, resulting in enlargement of the prostate gland
Does not predispose to development of prostate ca
- the most common urological problem in males
- as enlarge becomes a problem, it presses against the urethra & leads to obstruction (can be partial or complete)
Benign Prostatic Hyperplasia (BPH)
- Causes a narrowing of the urethra
- As prostate enlarges, it extends upward into bladder & inwards
- Bladder outlet obstruction is a result of the enlarged prostate
> urinary sx’s
BPH Cues
- urinary freq/hesitancy
- nocturia
- hematuria
- reduced force & size of urinary stream
- straining
- post-void dribbling
- UTI’s & renal calculi
> probably d/t incomplete emptying of bladder & urinary stasis
Possible Risk Factors
- Fhx
- Obesity (inc waist circumference)
- Physical activity lvl
- Alcohol consumption, smoking
- Diabetes
Recognize Cues: Diagnostic Studies
- HPE
- DRE
> is to palpate the prostate
> BPH feels soft, non-tender, whereas ca feels hard, tender to touch & w/irregular borders - Urinalysis w/culture
> to r/o UTI
- CBC
> to r/o any infections - PSA lvl
> to r/o prostate ca
> Normal is 4 or under - recent ejaculation or ejaculation within 24-48 hrs can falsely ↑ lvl
- BUN, creat
> assess kidney function - US
> can be done abdominally or rectally to look @ the prostate - Cystoscopy
> to look @ the bladder, bladder neck, & urethra. Is inserted through the urethra
Assessment
- experience any urinary sx’s?
- ask about urinary pattern, freq, how many times a night gets up
- any other sx’s of bladder obstruction?
> r/o either pt has BPH or if UTI or STD
IPSS - International Prostate Symptoms Score
- self-admin tool & pt reviews categories
Treatment options algorithm
BPH: Potential Complications
↠ UTI/sepsis
> primarily d/t incomplete emptying of the bladder
> leads to stasis of urine & inc bacterial growth
↠ Renal calculi
> d/t alkalization of the residual urine
↠ Renal failure
> by hydronephrosis
↠ Pyelonephritis
> from incomplete emptying of bladder & urinary stasis
↠ Bladder damage
> cumulatively from pt not emptying bladder completely
Non-Surgical Management
Drug Therapy
- depends on sx’s & severity of dz
- shrink the prostate by lowering the DHT, or dihydrotestosterone lvl
- constrict the prostate, reduce urethral pressure, & improve urine flow
- 5-alpha reductase inhibitors
- Proscar (finasteride)
- Avodart (dutasteride)
- alpha-1 selective blocking agents
- Flomax (tamsulosin)
- Hydride
- rx’s can take up to 6 mos to take effect
- s/e = dizziness, orthostatic hypotension, liver dysfunction
CAMs
- vitamins, herbs (Saw palmetto, lycopene)
> check for rx interactions - avoid caffeine, alcohol
- maintain an ideal wt
- inc activity & void as soon as you feel the urge
Thermal therapy
Destroys excess prostate tissue
- water-induced thermotherapy & transurethral ethanol ablation
Surgical Procedures
↠ Transurethral Resection of the Prostate (TURP)
↠ Prostatectomy
- Suprapubic
- Retropubic
- Perineal
- Which proc depends on pt’s gen cond, size of prostate gland, & man’s preference
- TURP most common
?
This is removal of the entire prostate that can be done for those pt’s whose sx’s are very severe
Prostatectomy
- suprapubicly, retropubicly, or perineal
?
A large portion of the prostate is removed endoscopically
- Requires less anesthesia & lowers rate of complications; epidural or spinal anesthesia
- Is safer for the high-risk person b/c a surgical incision is not used as opposed to an open incision
> Is no guarantee that the prostate tissue won’t regrow & enlarge >surgery (tissue growth takes yrs so pts may see results for a while)
Transurethral Resection of the Prostate (TURP)
CBI (Continuous Bladder Irrigation)
- 3-way urinary catheter w/a 30-45 mL retention balloon through the urethra into the bladder
- > a TURP or prostatectomy to irrigate & keep urinary flow clean; to make sure area is healing
- Traction via taping to pt’s abd or thigh
- left in place for 24-72 hrs depending on what urine looks like
! There’s going to be bleeding & 1 way to stop the bleeding is to flush the area w/solution
- Uncomfortable urge to void continuously
> d/t a 30-45 mL retention balloon in place (compared to a Foley cath balloon that’s 10cc)
! Small clots & reddish to pink tinge in the foley bag is expected but fluid should not have large clots or be completely dark red so you can’t see through it
- Antispasmodic rx’s
Postop Assessment of TURP
- Monitor for s/s of infection
- Monitor for confusion
- Monitor pain
- OOB asap
- Monitor color, consistency, & amt of urine output
> Subtract the amt that’s gone in from the total amt that you get in the drainage bag - Monitor for obstruction
Prostate Cancer
↠ Most common type of cancer in men
↠ Androgen-dependent adenocarcinoma
↠ Most common place is posterior lobe or outer portion of the prostate gland (whereas BPH is center)
- Slow-growing
- Metastasizes to lymph nodes, bones, lungs, liver; bones incl pelvis, sacrum, & L/S
Risk Factors
- Age >55 (median age 72)
- Diet low in fruits & vegetables
- Fhx
Screening
↠ DRE
↠ PSA
> ejaculation & infection will falsely elevate
↠ Biopsy
> done rectally
↠ TRUS (transurethral US)
Surgical Management
↠ TURP
↠ Laparoscopic radical prostatectomy
↠ Open radical prostatectomy
> to remove not only the prostate but seminal vessels & regional lymph nodes
> the pt will be sterile >a prostatectomy & may or may not have temporary or permanent ED
↠ Bilateral orchiectomy
> removes both testicles; will dec hormone production, slowing rate of ca
Complications of Radical Prostatectomy
↠ hemorrhage
↠ urinary retention
↠ infection
↠ wound dehiscence
↠ DVT
↠ PE
↠ ED
↠ Incontinence
Nonsurgical Management
↠ Radiation
* internal or external
> internal, or brachytherapy, done by inserting radiation seeds into & around the prostate gland; dose is low & not harmful to pt & others
> external beam rad therapy helps treat ca confined to prostate and/or surrounding tissues
↠ Hormones
↠ Chemotherapy
> for those whose ca has spread & other therapies haven’t worked
↠ Cryotherapy
↠ CAMs
- foods high in omega 3 fatty acids, lycopene, soy products, green tea
Nursing Management
↠ Education
↠ Provide support
↠ Suggest resources
↠ Relieve pain
Testicular Cancer
> Occurs in men 15-34
Unilateral or bilateral (bilat rare but can happen)
Germ cell vs non-Germ cell tumors
- Germ cell tumors arise from sperm-producing cells (! majority of ca’s)
- non-Germ cell tumors arise from cells that produce testosterone
> Teach self-examination
- has a high success rate; use surgery & chemo
Lab Assessment
> Alpha-fetoprotein (AFP)
Beta human chorionic gonadotropin (hcg)
Lactate dehydrogenase (LDH)
- elevation of 1 or more of these hormones will help determine what type of tumor it is & how to best treat the pt
> US, CT, MRI
Interventions
- Surgery (primary treatment)
- Chemotherapy
- Radiation
